Morning sickness heralds placental dysfunction
A LARGE study, published in BJOG, which examined more than 1.1 million birth records in Sweden, has found a strong association between hyperemesis gravidarum in the second trimester of pregnancy and placental dysfunction disorders. Compared with women not hospitalised for hyperemesis gravidarum, women hospitalised in the first trimester had a slightly increased risk of pre-eclampsia, while those hospitalised in the second trimester had more than double the risk of preterm (<37 weeks) pre-eclampsia, a threefold increased risk of placental abruption and a 39% increased risk of a baby born small for gestational age. Risks were adjusted for factors such as maternal age, parity, body mass index, height, smoking, infant’s sex, presence of hyperthyreosis, pregestational diabetes and chronic hypertension. The study authors wrote that pregnancies with hyperemesis gravidarum in the second trimester “demand an increased alertness and supervision for the development of adverse outcomes associated with abnormal placentation”.

Gift policies impact prescribing
GRADUATES of medical schools with policies restricting gifts from pharmaceutical companies may be less likely to prescribe new drugs over existing therapies, according to research published in the BMJ. The researchers compared the prescribing patterns for three newly marketed psychotropic drugs by doctors who had attended 14 US medical schools with active gift restriction policies with the prescribing patterns of doctors who attended 20 medical schools without such policies. For two of the three medications examined, attending a medical school with an active gift restriction policy was associated with reduced prescribing of the newly marketed drug. Students who had a longer exposure to the policy, or were exposed to more stringent policies, had even lower prescribing rates for the newer drugs. “Our findings suggest that conflict of interest policies, which have been increasingly adopted by medical schools since 2002, may have the potential to substantially impact clinical practice and reduce prescribing of newly marketed pharmaceuticals”, the study authors wrote.

Breast-conserving therapy benefits
WOMEN undergoing breast-conserving therapy (BCT) with radiation for early-stage breast cancer had improved overall survival and disease-specific survival (DSS) after 10 years of follow-up compared with women who underwent mastectomy, according to a population-based series published in Cancer. The DSS benefit with BCT compared with mastectomy was greater among women age 50 years or more with hormone receptor (HR)-positive disease than among women aged less than 50 years with HR-negative disease. The effect was observed regardless of HR status and age at diagnosis. The non-randomised study involved 112 154 women diagnosed with stage I or II breast cancer between 1990 and 2004 who were treated with either BCT or mastectomy. “These results provide confidence in the efficacy of BCT even among younger patients with HR-negative disease thought to be at relatively higher risk for local failure”, the authors wrote.

Prostate cancer treatments similar in long term
MEN treated for localised prostate cancer commonly have declines in urinary, bowel and sexual function in the long term, with prostatectomy and radiotherapy having similar long-term rates of decline in all functional domains, according to research published in the New England Journal of Medicine. The research involved 1655 men who were diagnosed with prostate cancer between the ages of 55 and 74 years and who had undergone either surgery (1164 men) or radiotherapy (491 men). Functional status was assessed at baseline and at 2, 5, and 15 years after diagnosis. While those who underwent prostatectomy were more likely to have urinary incontinence and erectile dysfunction and less likely to have bowel urgency after 2 and 5 years, there were no significant differences in functional outcomes between the groups after 15 years. “Considering the often long duration of survival after treatment for prostate cancer, these data may be used to counsel men considering treatment for localized disease”, the researchers wrote.

Placebo best for kids’ migraine
A SYSTEMATIC review of trial data on the use of triptans for migraine in adolescents, published in JAMA Pediatrics, has found a high placebo response rate. The authors of the study said the results were a “significant obstacle in triptan trials for treatment of adolescent migraine”. The placebo response of pain relief at 2 hours ranged from 53% to 57.5% in the trials. “Our analysis confirmed the high rate of placebo response as the likely main factor contributing to the failure of pediatric trials of abortive therapeutics for migraine. Our analysis also suggests that using pain relief at 1 hour after treatment as a primary end point is not effective in reducing the high placebo response rate”, the authors wrote. A second study in the same issue found that topiramate and trazodone had limited evidence supporting efficacy for episodic paediatric migraines and that placebo was effective in reducing headaches.

No benefits from selenium
A COCHRANE review of available evidence suggests that taking selenium supplements is neither beneficial nor harmful for cardiovascular disease (CVD) prevention, and is probably unnecessary in already well nourished adults. The review included nearly 20 000 adults who participated in 12 randomised controlled trials. The reviewers found no statistically significant effects of selenium supplementation on all cause mortality, CVD mortality and CVD events (fatal and non-fatal). There was a small increased risk of type 2 diabetes, alopecia and dermatitis with selenium supplementation but none of these reached statistical significance. There was also a reduction in total cholesterol that did not reach statistical significance, although there was a statistically significant reduction in non-HDL cholesterol in one trial of varying selenium dosage. The review authors said selenium was commonly added to multivitamin and mineral preparations, and selenium-enriched foods were widely used in many Western countries because selenium was perceived as an essential trace element for maintaining optimal health status. “Its use is also a result of aggressive marketing”, they wrote.

Posted 4 February 2013

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